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Cannulation configuration and recirculation in venovenous extracorporeal membrane oxygenation
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- Parker, Louis P. (författare)
- KTH,Linné Flow Center, FLOW,Teknisk mekanik
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- Marcial, Anders Svensson (författare)
- Karolinska Institutet
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- Brismar, Torkel B. (författare)
- Karolinska Institutet
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- (creator_code:org_t)
- 2022-09-30
- 2022
- Engelska.
- Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 12:1
- Tidskriftsartikel (refereegranskat)
Abstract
Ämnesord
Stäng
- Venovenous extracorporeal membrane oxygenation is a treatment for acute respiratory distress syndrome. Femoro-atrial cannulation means blood is drained from the inferior vena cava and returned to the superior vena cava; the opposite is termed atrio-femoral. Clinical data comparing these two methods is scarce and conflicting. Using computational fluid dynamics, we aim to compare atrio-femoral and femoro-atrial cannulation to assess the impact on recirculation fraction, under ideal conditions and several clinical scenarios. Using a patient-averaged model of the venae cavae and right atrium, commercially-available cannulae were positioned in each configuration. Additionally, occlusion of the femoro-atrial drainage cannula side-holes with/without reduced inferior vena cava inflow (0-75%) and retraction of the atrio-femoral drainage cannula were modelled. Large-eddy simulations were run for 2-6L/min circuit flow, obtaining time-averaged flow data. The model showed good agreement with clinical atrio-femoral recirculation data. Under ideal conditions, atrio-femoral yielded 13.5% higher recirculation than femoro-atrial across all circuit flow rates. Atrio-femoral right atrium flow patterns resembled normal physiology with a single large vortex. Femoro-atrial cannulation resulted in multiple vortices and increased turbulent kinetic energy at > 3L/min circuit flow. Occluding femoro-atrial drainage cannula side-holes and reducing inferior vena cava inflow increased mean recirculation by 11% and 32%, respectively. Retracting the atrio-femoral drainage cannula did not affect recirculation. These results suggest that, depending on drainage issues, either atrio-femoral or femoro-atrial cannulation may be preferrable. Rather than cannula tip proximity, the supply of available venous blood at the drainage site appears to be the strongest factor affecting recirculation.
Ämnesord
- TEKNIK OCH TEKNOLOGIER -- Maskinteknik -- Strömningsmekanik och akustik (hsv//swe)
- ENGINEERING AND TECHNOLOGY -- Mechanical Engineering -- Fluid Mechanics and Acoustics (hsv//eng)
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